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/ � S APPLICATION FOR SANITATION PERMIT l� 42 (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with ountyyOrdinance No. 549 DOCATION v �0-.- --------- ------------------------------------------------------------ JOB ADDRESS A !�5 __ 1 J/ ------------------------- Phone------------------------------------ Owner's Name ------------------------------------------- __2 -- Address------�� .0---------- ------49-e----- `------------- Contractor's Name__-Z- �- .� 99- 9__t-a. ----�---- ---- - -- - - --�-,- --- -C'r_-_,_•�------- -- - ------------------------------------ Phone---- ---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ANumber of baths Lot size______.Z__ Water Supply: Public system 6 Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe* Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ] well_____7 _ Distance from foundation______PA---_.Material___ _ _ _ __ ________________ _ � '_'No. of compartments _____ .___Ca Capacity _Oa Size____ ._____Li Liquid depth --- ______ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 0 Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building______________________-___________--_____. ❑ Distance to nearest lot line------------------------------------------------ r Seepa a Pit: Distance to nearest well_____ __'_Distance from f undation-___f �_---Distance to nearest lot line__.)�_ -_ Number of pits---------I------------Lining material_-_0r__tt_4__ Size: Diameter___ ------Depth-------Z_b__101------------ .Disposal Field: Distance from nearest well__-,,,A_"__.Distance from foundation-----_!-Q__-___:Distance to nearest lot line____-- -__- Number of lines-----------,f_-__,,,.____ Length of each line------S_'7 _ _____-Width of trench-.__-_ _ � _ ,Z_�_� ____ ___-_ t Type of filter material___��___/fJFo!_ _ Depth of filter material____f_.Z1 ---- -Remodeling -__Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and /rules and regulations of the San Joaquin Local Health District. (Signed)-- ... ,1--- --'-......1___ - �}�sem'%------------------------------------------------------------- -�_(OwnM•�wd/or Contractor) BY: - ` films - - -- --- -- - - (Title)-- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------- ------------------------------- DATE---------- d REVIEWEDBY---------------------------------------------------------------------- -------------- ---------------------------------- DATE------ - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ---- DATE------------------------------------------------------------ Alterations --------------------------------- -Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------ ------------------------- ------------ --- ------- --------------------------------- PERMIT No.__LI____-7 ISSUED------ L_____-______(Date) FINAL INSPECTION BY:___ _____t_,:--_-__________________-. Date------------------ - ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E$-9-2M 9-50 W-1639